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Quality and Equity in Wheelchairs Used by Veterans

  • Larissa Myaskovsky
    Correspondence
    Corresponding author Larissa Myaskovsky, PhD, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Bldg 30, Pittsburgh, PA 15240.
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
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  • Shasha Gao
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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  • Leslie R.M. Hausmann
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
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  • Kellee R. Bornemann
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
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  • Kelly H. Burkitt
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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  • Galen E. Switzer
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
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  • Michael J. Fine
    Affiliations
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
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  • Samuel L. Phillips
    Affiliations
    James A. Haley Veterans Hospital, Tampa, FL
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  • David Gater
    Affiliations
    Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA

    Pennsylvania State University Medical Center, Hershey, PA
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  • Ann M. Spungen
    Affiliations
    National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY

    Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
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  • Lynn Worobey
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA

    Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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  • Michael L. Boninger
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA

    Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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Published:October 03, 2016DOI:https://doi.org/10.1016/j.apmr.2016.09.116

      Abstract

      Objectives

      To assess in Veterans with spinal cord injury (SCI) or amputated limb (AL) the following: (1) patient demographics, medical factors, cultural and psychosocial characteristic by race; (2) wheelchair quality by race; and (3) the independent associations of patient race and the other factors with wheelchair quality.

      Design

      Cross-sectional cohort study.

      Setting

      Three Department of Veterans Affairs (VA) medical centers affiliated with academic medical centers.

      Participants

      Eligible participants were Veterans with SCI or ALs (N=516); 482 of them completed the interview. Analyses were restricted to white and African American participants. Because there was no variation in wheelchair quality among AL patients (n=42), they were excluded from all but descriptive analyses, leading to a final sample size of 421.

      Interventions

      Not applicable.

      Main Outcome Measure

      Wheelchair quality as defined by the Medicare Healthcare Common Procedure Coding System.

      Results

      We found race differences in many of our variables, but not in quality for manual (odds ratio [OR]=.67; 95% confidence interval [CI], .33–1.36) or power (OR=.82; 95% CI, .51–1.34) wheelchairs. Several factors including age (OR=.96; 95% CI, .93–.99) and income (OR=3.78; 95% CI, 1.43–9.97) were associated with wheelchair quality. There were no significant associations of cultural or psychosocial factors with wheelchair quality.

      Conclusions

      Although there were no racial differences in wheelchair quality, we found a significant association of older age and lower income with poorer wheelchair quality among Veterans. Efforts are needed to raise awareness of such disparities among VA wheelchair providers and to take steps to eliminate these disparities in prescription practice across VA sites.

      Keywords

      List of abbreviations:

      AL (amputated limb), CI (confidence interval), OR (odds ratio), SCI (spinal cord injury), VA (Veterans Affairs)
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